SIDS

SIDS: Sudden Infant Death Syndrome

CAUSES

No one knows for sure what the actual causes are for SIDS.  Although, statistically, SIDS does occur more often when parents do drugs (even certain prescribed drugs), or alcohol while the mother is pregnant.

If you do not fit the category of drug using , then the puzzle is even harder.  The most important thing to do is not take drugs or drink (including smoking marijuana), ask questions about prescribed drugs and consequences to the unborn fetus.  Make sure you eat well, drink lots of water, and do moderate exercise during your pregnancy.

ISOLATED FEELING AFTERWARDS

Many people feel isolated after the death of a baby or infant. People tend to think that you should “get over” the loss quickly.  This is especially true in the Lakota culture where the belief is the soul moves on after four days.

It may be difficult for you to grapple with your emotions, and especially anger or fear. The latter due to not understanding that there was not much you could have done to prevent SIDS.

AUTOPSY

If you have lost your baby due to SIDS, an autopsy may be required by law.  Or you may be encouraged to give permission for an autopsy. Unfortunately, with SIDS you may not get any answers to the causes of death nor on how to prevent SIDS in the future.

 

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Post- Partum Recovery Part 2

Postpartum Recovery After A Cesarean Section

And the Loss of Your Baby

 

AFTER CESAREAN DELIVERY

There may be two issues here: the grief of the loss of your baby, and the grief that you have because of having a Cesarean Section.  Another issue may be that you wonder why the Cesarean delivery wasn’t done sooner, and if it had been, would your baby have survived.

It is important, despite these mixed feelings, to allow your body to heal completely.  A Cesarean Section is a major surgery!  You may tire easily, even months after the surgery.  You may find that if you stand or walk for long periods of time that you tire out.  Allow time to heal before you resume your normal activities.

There may be particular restrictions your doctor may have regarding your activities after a Cesarean Section.  It may include the weight you can lift, mopping or vacuuming, even driving!  This is not the time to get all Super-woman!

Examine your incision daily to make sure it is healing properly. If steri-strips were used, leave them on until they begin to peel on their own.  Pay attention to any restrictions the doctor gives regarding bathing.

Call your Doctor or Midwife if you see the edges of the incision coming apart or any sign of infection. Also if:

  • You have increasing pain or tenderness
  • An increase in swelling or reddened skin around the incision
  • You develop a fever above 100 degrees
  • You have a continuing urge to urinate.

 

UTERINE HEALING

 

It is normal to have bleeding for up to 10 ten days after a miscarriage and eight weeks after delivery. The flow is called “lochia” and it consists of the material from the lining of the uterus, and blood from the area that the placenta was attached to the uterine wall.  Over a period of time it will change from red, to pink, to brown toa whitish yellow color.  Once in awhile there even may be clotting, with clots up to a quarter in size.  The flow will increase upon standing and/or increased activity.  This increase is indication to slow down, get some rest, and drink lots of water.

You should reduce vaginal penetration, including intercourse, tampons or douching for at least four weeks to reduce the chance of infection.  Your uterus (whether you have had normal birth or Cesarean Section) needs at least four if not up to six weeks to fully recover and heal.

Call your Doctor or Midwife if you have any concerns, or if you see any of the following:

  • Bleeding that saturates one or more sanitary pads in an hour
  • Dizziness, lightheadedness, especially if you have heavier bleeding
  • Unpleasant smelling vaginal flow or discharge
  • A fever of 100 degrees or more
  • Red, warm, or tender areas of the breasts or legs
  • If you are feeling ill or any new symptoms of discomforts arise.

Post-Partum Recovery Part 1

Postpartum Recovery
After the Loss of a Baby

 

YOUR EMOTIONS

Not only do you feel emotionally devastated, you may also feel that devastation physically.  You may feel fatigue, have insomnia, and the sensation of “empty arms”.

If you lost your baby in the womb, or at birth, you will have had all the signs of having been pregnant with not baby as a result.  While your body adjusts to have been pregnant, your non-pregnant hormonal levels may cause an additional postpartum blues (See hand-out: Postpartum Depression).  If the baby died while nursing, you still need to cope with the breasts that are producing milk.

You may feel anger at your body that is still recovering from the birth.  Even impatient for the signs of having been pregnant or having breast-fed, to go away.  Be sure to eat well (see handout:  ), get enough rest, and obtain the emotional support you need.  After the recovery from birth you will be more able to cope with the grief and be able to focus on your emotional recovery.

BREASTCARE

Due to the natural hormones of the body after you have delivered, your body will produce milk…even if you have not nursed your baby due to still birth.  The breast will feel full and uncomfortable the second to third day after delivery.

This engorgement period lasts up to 48 hours.  This “engorgement” is created by the pressure of the fluids in the breast.  If you use a breast pump to extract just enough milk to relieve the discomfort, the supply will diminish in time.

Some women prefer to just stick it out, and not pump the breast milk.  One risk of doing this is that you may develop a breast infection called “mastitis” (See handout: “Problems During Breastfeeding”).  You breast milk will be reabsorbed by the body if you wait it out.

Some books say to bind your breasts as a measure to help you.  It is now found that this is not a wise idea.  Using ice packs for the discomfort, 5-day regimen of B6, in 200mg. doses, or sit on hands and knees inside the tub with hot water deep enough to suspend your breasts. This allows for the breast milk to flow out without the stimulating effects of pumping, which would increase/continue milk production.

Call your Doctor or Midwife if you notice any of these signs of breast infection:

  • Redness, warmth, hardness or tenderness on the breast
  • Fever above 100 degrees.
  • Generally feeling ill
  • The lymph glands under the arms

Questions for Tests and Procedures

QUESTIONS FOR TESTS AND PROCEDURES

Use this handout to help you with the questions in order to get information to make a decision as to whether to have a test or procedure done. You have the right to know everything about your care. You have the right to refuse any treatment or test. You have the right to choose who will take care of you. Use both your head and heart to make the best choices for yourself.

TESTS

  • What is the name of this test?
  • What information will this test give?
  • What will it not tell?
  • Are there any risks associated with this test?
  • Are there other ways to get the same information?
  • How accurate is this test? Can it give a false negative or positive result?
  • If the results are negative, what will be done next? (Is this acceptable to you?)
  • If the results are positive, what will be done next? (Is this acceptable to you?)
  • What if you choose not to have this done?

PROCEDURES

  • What is the reason for this procedure?
  • What are the benefits?
  • What are the risks or side effects? (Are these acceptable to you?)
  • How is the procedure done?
  • Does this procedure always work? If not, why and how often?
  • If this procedure doesn’t work, what will be done next? (Is this acceptable to you?)
  • What other choices are available?
  • What are the potential consequences of not having the procedure done?

Western Culture & Colonization of Birth

Western Culture

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The West encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing.  In traditional cultures women “…prepare more symbolically.  They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and work on ‘letting go’. In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (Nichols & Humenick,145)” prior to childbirth.

Another aspect is that most women within many traditional cultures used to be more directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years.  The concepts used to have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experience and tradition has been lost or is no longer practiced today by women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience of their childbirth, if they speak up.

Traditionally, the birth of a baby was in the home, not a hospital.  Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today, birthing mostly takes place in a hospital setting.

Close to the reservation are border towns, where bias and prejudice color the atmosphere of birth. Due to past experiences with IHS, many women may opt to not have their babies at these hospitals. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today.

In border towns, the hospitals have their own regulations as to who may attend the birth. They may also decide on whether a woman can have assisted births (Nurse-midwives/doulas/or family supporters).

De-Colonization of Birth
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In the 90s, several women, including myself, were having weekly meetings regarding birth in Indian country. Each week we would have speakers come to share their stories and ideas.

I found it interesting that the biggest objections came via a native woman who was working at IHS. She bluntly stated that no midwife would work through the IHS hospital in Rosebud, if she had a say.

IHS or PHS is a government funded health organization in the United States intended specifically for native health care.  Unfortunately it has its own regulations based upon the government in which native people have been the object of clinical abuse and government sanctioned studies [such as the Eugenics Program; See: ]. The intent of these studies was to lower native populations.

Such historical actions color the way in which indigenous women see childbirth in the dominant society. It creates an atmosphere of distrust in native women, that they too would be subject to similar treatment.

And lest we forget, there have been studies that demonstrated genetic memories. So whether the Eugenics Program was known to them or not, the emotional trauma would still be triggered.

Native women feel marginalized by non-native providers of health care, due to attitudes of the providers. If native health care providers are not available, cultural competence of the health care provider that is on hand is an essential for the indigenous person giving birth. In a study conducted with first-nations women, specially the Mi’kmaq, Lothian stated that “Women need to be assured they can have trust in the birth process (Lavell-Harvard & Lavelle, 50)”.

There are native women who have become Doulas, and who are nurse-midwives. In Vancouver, BC there is a group of women from the Squamish people working to assist women [Ekw’i7tl Doula Collective]. In Minnesota there is a group of native people from the Anishinabe that is training women in Doula work, Childbirth Education, and Breastfeeding [Mewinzha Ondaadiziike Wiigaming /Bemidji, MN]. In New Mexico the first native birthing center [The Changing Woman Initiative] is being developed for  indigenous women.

 

 

 

Cultural Perspectives on Childbirth

co sleeping

Every aspect of who we are from our behaviors to our learning processes is framed by our culture. The whole idea of a “melting pot” in America where many cultures blend to become one culture, is a fallacy.  People of like cultural and ethnic background tend to gravitate towards what is similar and familiar.  It shapes their identity.

This is particularly true of treaty nations (indigenous peoples) who struggle to keep their own tribal identity. Even in the cities, away from reservations, native people gravitate toward what is familiar and comfortable (besides where else would they get some Indian Tacos?).

Every indigenous group has their own cultural beliefs, rituals and traditions. Even for pregnancy and childbirth.  How childbirth took place was shaped by cultural values, ways of knowing, and framed within ritual and belief.

Unfortunately the cultural aspects were not all preserved and kept in all tribal groups, due encroachment from white society.  This encroachment has created a rift in fabric of cultural life. “The culture in which people grow up is one of the key influences on the way they see and react to the world and the way they behave (Nichols & Humenick, 139).”

For many cultures, including the Lakota, pregnancy and childbirth is much more than just a physical act.  It is believed that a spiritual force is at work.  Concepts, customs, and traditions develop around these spiritual beliefs.

Here are some of the sites I found, for other cultures:

http://www.midwiferytoday.com/articles/immexico_healing.asp

http://www.louisianafolklife.org/LT/Articles_Essays/main_misc_wait_babies.html

http://ihst.midwife.org/ihst/files/ccLibraryFiles/Filename/000000000004/IHS%20Midwives.pdf

Multi-cultural Beliefs

Within each indigenous culture are the ideas and concepts that surround the actions of the pregnant woman, her diet, how others should act when around her.  Some ideas and traditions actually carry across into multiple cultures around the world.

One concept has to do with knots and ties. That if these were within view of a pregnant woman, or she stepped across them, it would cause the umbilical cord to be tangled at birth. Another has to do with actions of others. If you fight around a pregnant woman or with one, it causes problems with her pregnancy.

For most indigenous cultures there are concepts taught regarding the spiritual aspects of birth and early childhood. There is a belief that a female spirit that assists in childbirth, for the Lakota people, and also assists the soul of the child in “picking” the family in which they will be born.  In western society, what they call the “Mongolian Marks” is what this female makes when a spirit is born in our world.

Infants and young children (until age 5) are considered “sacred beings” and our actions with them must be tempered by this belief.  They are closer to the spirit world, in Lakota belief.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child.  This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe.  This is true whether they have a traditional spiritual base and upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and a part of the spiritual birthing process.

Next: the Western Culture & De-Colonization of Birthing

FYI for native women

Just an FYI for all of you…

 

Midwives Resistance: How Native Women are Reclaiming Birth on Their Terms

Mana Preconference/for native midwives

2 FULL DAYS:

Indigenous Midwifery: Ancestral Knowledge Keepers – $150. (Proceeds go to Native American Midwives Alliance)

When: October 14-15, 8:00-5:00PM

Indigenous Birthworkers Network Birthworkers who are Midwives, Doulas, mothers…

Midwifery is On the Rise In Native Communities

Nicolle Gonzales CNM ~ Blessingway of a Native American Midwife  Video

Midwives of Color

2018 American Indian and Alaska Native National Behavioral Health Conference

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Birth Trauma Part 3

According to Cheryl Tatano Beck, traumatic birth is defined as “an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother  or her infant. The birthing woman experiences intense fear, helplessness, loss of control, and horror” she had later revised that statement to include the woman feeling stripped of her dignity.

What is the cause of women perceiving their birth experience as traumatic? It is the systemic elimination of protective care during the birthing process.

In Beck’s study of 40 women she says that there were four themes that emerged. Theme #1 was to care for the women and treating them as human beings. Theme #2: Lack of Communication.  Theme #3 was safety. Theme #4: The ends will justify the means.

With theme One: #1 women feeling they were objectified, and treated arrogantly and with a lack of empathy. The women were #2 left alone, and abandoned. The #3 birthing mother’s needs were not met by the hospital staff. An example given was of a woman from Puerto Rico who was on all fours, when a nurse brought in 20 students to observe…without her consent.

In theme Two: #1 no one communicated with the woman in labor. They were described as having conversations with one another within earshot but not directly talking with or to the laboring mother. As if she were non-existent.

In the third theme:  the #1 laboring mothers felt that the staff (nurses and doctors) did not adequately deliver safe care. #2 The mothers were not being allowed input into the care being given for their own selves and actually fearing for their own and / or the infant’s life!

In theme Four:  entailed #1 the sense that what was endured and experienced by the mothers was the sense of being “pushed to the background” as everyone around them were celebrating the baby’s healthy birth. These women #2 felt invisible, only the infant mattered.

The experiences mothers have had led to severe post-partum trauma and depression.  Beck, Driscoll, and Watson’s book Traumatic Birth goes into detail about feedback loops [pp. 10-12] that describe the interaction of the mother and child after a traumatic birth, with a listing of the causes and consequences of the cause. Sometimes even breastfeeding is difficult, creating “…intruding flashbacks, disturbing detachments with their infants, feeling violated, enduring physical pain, and insufficient milk supply…” Often the anniversary of a traumatic birth amplifies the feedback loop.

 …

My own reaction to the shared experiences the women in this book had illustrated the barbarism of western medical professionals, a barbarism that is completely contrary to those principles I listed from the ACOG website in part #2.

The women who tell their story of childbirth weave an astounding sense of personal alienation.  It is no wonder that there is PTSD, depression, self-destructive behaviors, socially isolationistic behaviors and pelvic floor injuries as a result of the improper calloused form of care received. Many of the women feel as though they were raped, yet most had no “history of physical, emotional, and/or sexual abuse” so birth precipitated  a sense of having “the loss of the soul”.

I only touched on a small portion of the book in these three posts. In the next few blogs, I would like to address how we can alter the outcome for women in these circumstances and possibly change childbirth for women.

Birth Trauma – Part 2

What can you do to prevent problems in labor, and miscommunication with your doctor? My recommendation is to follow the recommended diet for pregnancy, exercise (for pregnant women), drink a lot of water, and attend to the prenatal visits.

Never be afraid to ask questions!

Why a certain test is being done, what does that word mean, etc. Some things I can assist you with during the Childbirth Education coursework…but asking the questions of your doctor is important. You get to know your doctor, and he/she can get to know you.

Your right as a patient is to have any procedure or test explained to you, by your doctor.

Questions such as:

-Is the particular procedure / test done because it is required?
-Who requires it?
-Why is it required?
-Is it because of doctor concern? What precipitated that concern?

Your doctor is not GOD.

If the doctor is not responding to your questions or you are not comfortable with the explanation / or attitude of the doctor you still can address the issue. Sometimes just a rewording of your question is helpful.  If still you are not being listened to, the following outlines your rights…

HIPPA law outlines a patient’s rights:

To Clear Communication

The AMA’s Code of Medical Ethics clearly states that it is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions.
[https://www.emedicinehealth.com/patient_rights/article_em.htm#communication ]

To Informed Consent

Informed consent involves the patient’s understanding of the following:

  • What the doctor is proposing to do
  • Whether the doctor’s proposal is a minor procedure or major surgery
  • The nature and purpose of the treatment
  • Intended effects versus possible side effects
  • The risks and anticipated benefits involved
  • All reasonable alternatives including risks and possible benefits.

[https://www.emedicinehealth.com/patient_rights/article_em.htm#informed_consent ]

Within the perimeters of informed consent, the doctor ethically understands the responsibility of:

  • The patient being told what the doctor is going to do
  • That the patient is helped to understand the medical implications
  • Whether it is a minor or major procedure
  • The risks and benefits
  • Alternatives with the information about risks and benefits

The patient rights also include:

  • Freedom from force, fraud, deceit, duress, overreaching or other ulterior form of constraint or coercion
  • The right to refuse or withdraw without influencing the patient’s future healthcare
  • The right to ask questions and to negotiate aspects of treatment

    The 3rd part follows in one week…

Birth Trauma – Part 1

Many things come up during the labor and birthing of a baby. These may or may not be emergency-level events. A woman in labor is focused on the process they are involved in: birth. The woman may not be aware of what is being discussed around them, nor the things happening that may alter their ideals of the “perfect”  birth.

Here are some things that may occur:

  • Slow dilation of the cervix
  • Labor stalling
  • Movement of the baby stops
  • Blood pressure of the mother rises

Often doctors in the hospital will want to intervene. The remedies may be interventions that you really do not need.

These interventions could possibly be:

  • Monitors
  • IV insertion
  • Inducing labor (Pitocin)
  • Or even the decision to have a c-Section (read my blog post on this here: )

The first two  can be alleviated by using gravity (walking, dancing, leaning forward onto the labor bed with feet on the floor and doing squats). Usually stressors or nervousness are the cause.

With Labor stalling, if already dilated 6-7cm, it could very well be a natural stall while going into the next stage of labor or “Transition” (Balaskas 127-131). Body tension can also effect how labor progression.

Low moaning sounds are effective here, in that the vocal cords being activated relaxes the sphincter muscle group of the pelvic floor, as Ina May states ” The state of relaxation of the mouth and jaw is directly correlated with the ability of the cervix, the vagina, and the anus to open to full capacity (Ina Mays Guide, 170). The sphincter muscles will close due to stress or fear. Goer suggests that “obstetric management can obstruct progress (The Thinking Woman’s, 108)”

Remember: Babies are birthed when they are READY. Not on some sort of perceived time schedule.  This is a process that cannot be forced.

If the baby stops movement, inform your doctor. You can use “kick counts” as a method to monitor movements if you are concerned. In active labor, the baby tends to move in a spiral as baby moves into birthing position . Sometimes stopping movement for a short period of time can be an indicator of  the baby 1) shifting position 2) resting before birthing.

Blood pressure issues could be gestational diabetes, or just stress. The cause for the blood pressure rising needs to be found. High blood pressure is also a symptom of pre-eclampsia. But if you were not having signs of this condition and diagnosed in pregnancy (which is why prenatal visits are essential) then it may be something else.

Of course, water by mouth could assist in lowering the blood pressure level. Here is suggested reading for you to understand the seriousness of this condition: https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy

So now we move onto the second part of this discussion, published one week from this page.